"Awareness of the association between ADHD [attention-deficit hyperactivity disorder] and SSBs [suicidal spectrum behaviors] should contribute to more effectively prevent SSBs."
That was the conclusion reached in the study published by Mathilde Septier and colleagues [1] and the results of their "first meta-analysis on the association between ADHD and SSBs taking possible confounders into account." Their systematic review and meta-analysis was preregistered (see here) so we knew it would be coming.
Starting with nearly 3000 references, the available data was whittled down to just over 50 studies. The data were analysed and boiled down to reveal "a significant association between ADHD and suicidal attempts..., suicidal ideations..., suicidal plans..., and completed suicide."
What's more to say? Well such results although stark are not completely unexpected given what has already been discussed on this blog on this topic (see here and see here and see here). They serve to confirm that a diagnosis of ADHD (or even the presentation of subclinical ADHD symptoms?) should really set in motion some preferential screening for suicidal spectrum behaviours and appropriate support offered as and when detected. Minus any sweeping generalisations, such results also invite further inquiry into how certain intervention options indicated for ADHD *might* also affect risk of suicidality in the context of ADHD (see here).
If you need someone to talk to, there are organisations out there...
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[1] Septier M. et al. Association between suicidal spectrum behaviors and Attention-Deficit/Hyperactivity Disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2019 May 23. pii: S0149-7634(18)30941-2.
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Showing posts with label suicide. Show all posts
Showing posts with label suicide. Show all posts
Saturday, 13 July 2019
Wednesday, 5 June 2019
"specific clinical and neuropsychological dimensions might be related to suicidal behaviors in ASD"
The quote titling this post - "specific clinical and neuropsychological dimensions might be related to suicidal behaviors in ASD [autism spectrum disorder]" - comes from the findings reported by Luisa Weiner and colleagues [1] (open-access). It adds to other recent research talking about how elements of autism *might* associate with suicidality (see here). I should warn you that some of the Weiner findings make for difficult reading.
Authors described a case report of "a 21-year-old male [Mr A] with ASD who attempted suicide twice, in the absence of other psychiatric diagnoses." They detail how, following some quite comprehensive observations, a possible *connection* was noted between his suicidality and "some of the core clinical and neuropsychological features of ASD."
A few important points are highlighted in the Weiner study: "Mr. A. reported that his suicidal thoughts started when he was 18, following an unrequited infatuation with a classmate – the result of a rational decision: he had decided to “fall in love” with her." Things did not however go as he planned, as we are told that: "He started having “obsessive negative thoughts”, and attempted suicide by jumping from a window." He survived but "his suicidal thoughts lingered, characterized by a restrictive, rigid pattern."
Researchers relied on the Beck Depression Inventory (BDI) to rule out depression in this case: his score "was in the normal range (3/63)." This inventory is one of a few that have been described as being "robust in their measurement properties in the general population" [2] but with perhaps more to do in the context of its use in autism. In the absence of depression or rather elevated self-report scores indicative of depression, authors suggest this raises "the question of whether the persistence of suicidal thoughts was associated with ASD-related features."
The Weiner findings have to be placed in the context of other independent research looking at suicidality and autism. First, risk of suicidality is seemingly heightened when autism is diagnosed (see here). Second, although depression - an important variable *linked* to suicidality - is over-represented in relation to autism (see here), questions are still being asked about the impact of depression in relation to suicidality accompanying autism in the context of an often complicated clinical picture (see here). Third, the idea that the features/traits of autism might themselves be independent predictors of suicidality in autism has been discussed on several research occasions (see here and see here and see here).
The culmination of all this work is that quite a lot more research and clinical resources need to be ploughed into looking at suicidality and autism. And, importantly, translating said research into real-world actions to potentially save lives.
If you need someone to talk to, there are organisations out there...
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[1] Weiner L. et al. A case study of suicidality presenting as a restricted interest in autism Spectrum disorder. BMC Psychiatry. 2019; 19: 126.
[2] Cassidy SA. et al. Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Res. 2018 May;11(5):738-754.
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Authors described a case report of "a 21-year-old male [Mr A] with ASD who attempted suicide twice, in the absence of other psychiatric diagnoses." They detail how, following some quite comprehensive observations, a possible *connection* was noted between his suicidality and "some of the core clinical and neuropsychological features of ASD."
A few important points are highlighted in the Weiner study: "Mr. A. reported that his suicidal thoughts started when he was 18, following an unrequited infatuation with a classmate – the result of a rational decision: he had decided to “fall in love” with her." Things did not however go as he planned, as we are told that: "He started having “obsessive negative thoughts”, and attempted suicide by jumping from a window." He survived but "his suicidal thoughts lingered, characterized by a restrictive, rigid pattern."
Researchers relied on the Beck Depression Inventory (BDI) to rule out depression in this case: his score "was in the normal range (3/63)." This inventory is one of a few that have been described as being "robust in their measurement properties in the general population" [2] but with perhaps more to do in the context of its use in autism. In the absence of depression or rather elevated self-report scores indicative of depression, authors suggest this raises "the question of whether the persistence of suicidal thoughts was associated with ASD-related features."
The Weiner findings have to be placed in the context of other independent research looking at suicidality and autism. First, risk of suicidality is seemingly heightened when autism is diagnosed (see here). Second, although depression - an important variable *linked* to suicidality - is over-represented in relation to autism (see here), questions are still being asked about the impact of depression in relation to suicidality accompanying autism in the context of an often complicated clinical picture (see here). Third, the idea that the features/traits of autism might themselves be independent predictors of suicidality in autism has been discussed on several research occasions (see here and see here and see here).
The culmination of all this work is that quite a lot more research and clinical resources need to be ploughed into looking at suicidality and autism. And, importantly, translating said research into real-world actions to potentially save lives.
If you need someone to talk to, there are organisations out there...
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[1] Weiner L. et al. A case study of suicidality presenting as a restricted interest in autism Spectrum disorder. BMC Psychiatry. 2019; 19: 126.
[2] Cassidy SA. et al. Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Res. 2018 May;11(5):738-754.
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Tuesday, 14 May 2019
"Ruminative thinking is the autistic dimension more strongly associated with suicidality"
The quote titling this post - "Ruminative thinking is the autistic dimension more strongly associated with suicidality" - comes from the findings published by Liliana Dell'Osso and colleagues [1] and provides something of an extension of previous work from authors on this paper (see here).
The important topic under investigation by Dell'Osso et al was suicidality; something that crops up time and time again in connection to the autism spectrum (see here). No, such a topic doesn't make for great PR 'about autism'. But if you want to talk about research/clinical priorities when it comes to the autism spectrum, I can't think of many topics that would be more pressing...
The hypothesis: those with subthreshold autistic traits (AT) and autism spectrum disorder (ASD) "will both show a higher prevalence of suicidal ideation and behaviors" when compared with asymptomatic controls. Further: "to clarify if AT do actually imply a risk factor for suicidality similar to full-blown ASD, hypothesizing that suicidal thoughts and behaviors will not differ between subjects with subthreshold autism and full-blown ASD." Similar sentiments have been previously expressed in other research results (see here and see here and see here).
I won't bore you with all the details of the hows-and-whys of Dell'Osso study (it is open-access) but do want to focus in on a few important observations made. First authors reported that they "found no differences in suicidality scores between ASD and AT groups, while both showed a higher score than HC [healthy controls]." I might add that 'HC' is a term used by the authors and wouldn't be my choice for describing a control group. This finding is important not just for autism but potentially for lots of other labels that manifest autistic traits (see here and see here) on the basis that autistic traits are not necessarily exclusive to a diagnosis of autism.
Second: "the ASD group reported significantly higher MOODS-SR total score and MOODS-SR depressive component score than the AT group, and the AT group in turn scored significantly higher than the HC." I don't think anyone should be really surprised by the finding that the symptoms of mood disorders such as depression seem to be 'over-represented' alongside a diagnosis of autism given other data on this issue (see here). Indeed, one might even say that depression could, for some autistic people, be considered a core issue over and above just being described as a comorbidity (see here).
Finally I head back to the title of this post, and how something like ruminative thinking - "a pattern of repetitive thinking, usually associated to and exacerbating anxiety and depression, often affecting problem-solving and the processing of negative feelings and leading to social isolation" - might be a particular dimension *associated* with suicidality in the context of autism or the presentation of subthreshold autistic traits. I've talked a few times about rumination in the context of autism on this blog (see here and see here). Rumination has also been talked about in the context of autism and suicide before too (see here). If research continues to point to rumination as something important, one might potentially envisage the development of interventions that could ameliorate such an issue and possibly onward *affect* the risk of something like suicidality?
I don't want anyone to get the impression that the Dell'Osso findings have *solved* the issue of suicidality in the context of autism because they haven't. As I've said many times before on this blog, suicide is a very, very complicated and deeply personal issue (see here) with no one-size-fits-all answer to the questions it raises. As part of a larger picture however, the Dell'Osso results are however important. If their application in a clinical context saves even one life, I would consider that to be infinitely worthwhile.
If anyone needs someone to talk to, there are people who will listen (see here and see here)...
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[1] Dell'Osso L. et al. Mood symptoms and suicidality across the autism spectrum. Comprehensive Psychiatry. 2019. April 3.
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The important topic under investigation by Dell'Osso et al was suicidality; something that crops up time and time again in connection to the autism spectrum (see here). No, such a topic doesn't make for great PR 'about autism'. But if you want to talk about research/clinical priorities when it comes to the autism spectrum, I can't think of many topics that would be more pressing...
The hypothesis: those with subthreshold autistic traits (AT) and autism spectrum disorder (ASD) "will both show a higher prevalence of suicidal ideation and behaviors" when compared with asymptomatic controls. Further: "to clarify if AT do actually imply a risk factor for suicidality similar to full-blown ASD, hypothesizing that suicidal thoughts and behaviors will not differ between subjects with subthreshold autism and full-blown ASD." Similar sentiments have been previously expressed in other research results (see here and see here and see here).
I won't bore you with all the details of the hows-and-whys of Dell'Osso study (it is open-access) but do want to focus in on a few important observations made. First authors reported that they "found no differences in suicidality scores between ASD and AT groups, while both showed a higher score than HC [healthy controls]." I might add that 'HC' is a term used by the authors and wouldn't be my choice for describing a control group. This finding is important not just for autism but potentially for lots of other labels that manifest autistic traits (see here and see here) on the basis that autistic traits are not necessarily exclusive to a diagnosis of autism.
Second: "the ASD group reported significantly higher MOODS-SR total score and MOODS-SR depressive component score than the AT group, and the AT group in turn scored significantly higher than the HC." I don't think anyone should be really surprised by the finding that the symptoms of mood disorders such as depression seem to be 'over-represented' alongside a diagnosis of autism given other data on this issue (see here). Indeed, one might even say that depression could, for some autistic people, be considered a core issue over and above just being described as a comorbidity (see here).
Finally I head back to the title of this post, and how something like ruminative thinking - "a pattern of repetitive thinking, usually associated to and exacerbating anxiety and depression, often affecting problem-solving and the processing of negative feelings and leading to social isolation" - might be a particular dimension *associated* with suicidality in the context of autism or the presentation of subthreshold autistic traits. I've talked a few times about rumination in the context of autism on this blog (see here and see here). Rumination has also been talked about in the context of autism and suicide before too (see here). If research continues to point to rumination as something important, one might potentially envisage the development of interventions that could ameliorate such an issue and possibly onward *affect* the risk of something like suicidality?
I don't want anyone to get the impression that the Dell'Osso findings have *solved* the issue of suicidality in the context of autism because they haven't. As I've said many times before on this blog, suicide is a very, very complicated and deeply personal issue (see here) with no one-size-fits-all answer to the questions it raises. As part of a larger picture however, the Dell'Osso results are however important. If their application in a clinical context saves even one life, I would consider that to be infinitely worthwhile.
If anyone needs someone to talk to, there are people who will listen (see here and see here)...
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[1] Dell'Osso L. et al. Mood symptoms and suicidality across the autism spectrum. Comprehensive Psychiatry. 2019. April 3.
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Saturday, 27 April 2019
"The burden of care of mothers as caregivers of ASD children leads to suicidal ideation among them"
I appreciate that the title heading this post - "The burden of care of mothers as caregivers of ASD [autism spectrum disorder] children leads to suicidal ideation among them" - derived from the findings reported by Bushra Akram and colleagues [1] is (a) a rather sweeping generalisation, and (b) not likely to be met with great enthusiasm by some/many people. I say that on the basis that words like 'burden of care' carry significant emotional meaning, even if only trying to describe "the psychological, emotional, social and economic challenges that are experienced by a caregiver of mentally or physically ill person."Language aside, I did want to blog about the Akram findings because they represent another uncomfortable topic that needs to be talked about and further researched in relation to autism. They bring to our attention how parenting is not always about smiles, fluffy clouds and rainbows but sometimes can be bloody difficult. More so when something like autism is part and parcel of the family unit (see here and see here). Such recognition of reality is not meant to stigmatise anyone or devalue them as a person. It merely implies that burying heads in the sand for the sake of good PR or other reasons helps no-one in the long run. Least of all children. And in that respect, there seems a change recently (see here)...
I think you've kinda got the gist of what Akram et al were looking at in their study. They managed to recruit over 300 mums of children diagnosed with an autism spectrum disorder (ASD) from various cities in Pakistan. Diagnosis was apparently 'assessed' via DSM-5 criteria (see here). We're also told that: "Single mothers or those with more than 1 child with disability were excluded." Various questionnaires were delivered to participants - "the 19-item Burden Assessment [Scale]... (BAS), 12-item Multi-Dimensional Scale of Perceived Social Support...(MSPPS) and 5-item Suicidal Ideation Attributes Scale... (SIDAS)" - pertinent to the study aims. The quality of the translation of some of the instruments into Urdu was tested on a favourite cohort, psychology students.
Results: "The relationship between burden of care and suicidal ideation was positive, but perceived social support had a negative association with burden and with suicidal ideation." What this translates into is that if mums reported that a high score when it came to 'burden of care' so their scores regarding suicide ideation also seemed to be high. Also, if mums perceived themselves to have little or less social support, so they more more likely to experience a burden of care and/or suicidal ideation. This is important if not entirely unexpected.
Of course there are other potential explanations for the findings. Depression, something that seems to have some important links to something like suicidal ideation, was not looked at in the Akram study. Given some previous independent research on depression in parents/guardians of children with autism (see here), depression can't be discounted as playing an important role in suicidal ideation in this case. Likewise, factors such as money and employment would probably play some sort of role too. There are probably a myriad of other intrinsic and external variables to consider.
But let's not over-analyse this over-and-above the actual results obtained by Akram. They really do make a case of more 'caring for the carers' investigation and action (see here). Minus any psychobabble [2] it's the small things that can make a difference. Y'know, things like offering respite to parents/guardians (see here) and ensuring that in these days of a connected world, parents/guardians of children with autism are also connected too (see here). I know it's not politically correct in some quarters to mention it, but such data also make a good case for looking at what can be done to alleviate/reduce some of the more challenging behaviours that can make parenting a child with autism more difficult. Oh, and whilst on the topic of parenting, yes, there is a place for helping parents who are struggling to manage and cope via the teaching of various strategies, but please, leave off the 'super-parenting' stuff for now (see here). Many parents are already super-parents.
And whilst on the topic of caring for the carers, it's worthwhile mentioning that where an autistic child has siblings they also require 'parenting' attention too (see here)...
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[1] Akram B. et al. Burden of care and Suicidal Ideation among Mothers of Children with Autism Spectrum Disorder: Perceived Social Support as a Moderator. J Pak Med Assoc. 2019; 69: 504.
[2] Lee GK. et al. Needs, strain, coping, and mental health among caregivers of individuals with autism spectrum disorder: A moderated mediation analysis. Autism. 2019 Mar 20:1362361319833678.
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Wednesday, 20 February 2019
T. gondii infection might be "a contributing causal factor for schizophrenia"
T. gondii mentioned in the title of this post refers to Toxoplasma gondii, a parasite with something of a rather interesting profile and history (see here and see here). I've talked quite a bit on this blog about T. gondii and it's various 'associations', but of particular interest has been the suggestion of a 'connection' between T. gondii exposure and risk of psychiatric diagnoses like schizophrenia (see here).The findings reported by Kristoffer Sølvsten Burgdorf and colleagues [1] (open-access available here) add further evidence to such a 'psychiatric' connection with their conclusion that: "exposure to T. gondii might be a contributing causal factor for developing schizophrenia." Researchers arrived at their conclusion following the examination of an intriguing initiative called the Danish Blood Donor Study (DBDS). Started in 2010, the DBDS includes records for over 100,000 patients and "contains DNA and EDTA plasma samples, consecutive for all donors returning for blood donation after enrolment." That's a lot of data. So: authors "identified all individuals in the DBDS cohort registered with psychiatric disorders, suicidal behavior, or traffic accidents (N=5,953)." Said participants were matched with 'suitable' controls (N=7,101) and stored samples were analysed for "immunoglobulin (IgG) class antibodies against T. gondii and CMV." CMV by the way, refers to cytomegalovirus. Contact with (congenital) CMV has also been talked about on this blog (see here). CMV (exposure) also shares a potential *link* with "psychiatric disorders, cognitive deficits, suicidal behavior, and traffic accidents."
Results: "Of the 11,546 studied individuals, 2,990 and 7,020 individuals, respectively, tested positive for IgG class antibodies against T. gondii (25·9%) or CMV (60·8%)." Onward: "We found that individuals with a T. gondii infection had increased odds of being diagnosed with schizophrenia disorders compared to those without infection." Because researchers were also able to access other national databases containing details on outcomes like diagnosis of a psychiatric disorder and 'attempting suicide' and cross-reference them with their participants, they were also able to look at "temporality, with pathogen exposure preceding outcome" as a factor. And when they did, that T. gondii exposure - schizophrenia association was described as "even stronger." The other data on T. gondii or CMV exposure in relation to traffic accidents or suicide attempts was not as statistically strong, and indeed nothing showed significance when temporality was taken into consideration in relation to causation. On that basis, I'm gonna leave that part of the results without further comment.
This was a good study. It drew on data from a well-defined group (those Scandinavian databases 'do it' yet again) and was able to take into account the important issue of temporality. It wasn't a perfect study - "We cannot rule out that socio-economic factors could potentially account for part or all of the observed causal effect" - and said nothing about possible mechanism(s) of effect however. That being said, I'm willing to go along with the conclusions made and the need for a lot more investigation in this area linking T. gondii exposure and subsequent risk of mental illness. In particular whether new or existing treatment methods for T. gondii *might* hold the promise of much more...
And whilst on the topic of T.gondii and the specific input from cats on the spread of T. gondii (see here and see here), I'll state here and now that I am not a great believer in the idea of 'cat eradication' as mentioned by some researchers recently [2]. That being said, a toxoplasmosis vaccines for cats (see here) sounds like a really good idea...
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[1] Sølvsten Burgdorf K. et al. Large-scale study of Toxoplasma and Cytomegalovirus shows an association between infection and serious psychiatric disorders. Brain Behav Immun. 2019 Jan 24. pii: S0889-1591(18)30699-8.
[2] de Wit LA. et al. Potential public health benefits from cat eradications on islands. PLoS Negl Trop Dis 13(2): e0007040
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Wednesday, 6 February 2019
Suicide risk and autism: data from "Utah over a 20-year period"
The findings reported by Anne Kirby and colleagues [1] are not for the faint-hearted but continue a vitally important theme in autism research and practice circles looking at suicide risk and autism (see here and see here). The 'value-added' bit to the Kirby results to distinguish them from other study in this area was the reliance on data across a 20-year period from a place that has some important autism research history: Utah in the United States (see here).So: "Four sources of existing data were utilized for this study: URADD statewide autism surveillance data, statewide suicide surveillance data collected by the Utah Office of the Medical Examiner (OME), the UPDB, and Utah's Indicator‐Based Information System for Public Health (IBIS‐PH)." From such data sources, researchers accessed information for nearly 17,000 people diagnosed with an autism spectrum disorder (ASD) "alive at the beginning of 1998 and at least 5 years of age in 2013." Most were male and most were white. They similarly determined that nearly 9,000 people in their total population - not just those diagnosed with ASD - died by suicide between 1998 and 2017. Again, most were male and most were white. The data were combined and interrogated "to calculate the incidence (in 5‐year intervals) of suicide deaths in people with ASD over a 20‐year period (1998 to 2017) in total, as well as by sex, and compared suicide risk in people with versus without ASD." Researchers also looked at other important variables such as "sex, race, death age, occupational status, marital status, and manner of death" across the groups.
Results: "In the first 15 years of the study (1998–2012), we did not observe differences in suicide cumulative incidences between the ASD and non‐ASD populations." This means that when the groups were compared as a function of death by suicide, the figures for those with autism were not significantly different from those without autism for this time period. By saying that I don't want to belittle the fact that between 1998 and 2012 for example, 2 people out of 5,202 autistic people died by suicide or that 1,671 out of 1,928,484 non-autistic people died. Each of these figures was a person with a life and with a family, and that's something that should never ever be forgotten.
The pattern however changed when researchers looked at the period between 2013 and 2017: "For the most recent time interval (2013–2017), the cumulative incidence of suicide death in the ASD population was 0.17%, which is significantly higher than the non‐ASD population cumulative incidence of 0.11%." This percentage (0.17%) represented 28 deaths from an autistic population of 16,907 and 2,791 deaths from a non-autistic population of 2,630,221. Although a sideline point, I'll also bring to your attention how the autistic population numbers changed over the 5-year blocks of study in the Kirby paper: 1998-2002: 5,202 people; 2003-2007: 8,722 people; 2008-2012: 13,890 people; 2013-2017: 16,907 people.
A few other details were observed by Kirby et al: "In comparison with non‐ASD + suicide cases, ASD + suicide cases had significantly younger average death ages (32.4 years vs. 41.8 years; t = −3.8, P < 0.001)." Also: "Combined, 73% of the ASD + suicide cases used methods for suicide considered to be violent; the remaining 26% used nonviolent methods." This again, is important information.
Researchers also mention how across the 2013-2017 period, another important trend was observed: "suicide risk in females with ASD was over three times higher than in females without ASD (relative risk (RR): 3.42; P < 0.01)." They contrast this with the finding that "there were no documented cases of suicide death among females with ASD during the first 15 years of the surveillance period" and what this could mean when it comes to possible explanations of suicide risk in relation to autism.
There's quite a bit to learn from the Kirby findings. Although there are limitations attached to the study design - "inadequate data on intellectual ability was available to examine the influence ID may have on suicide risk in individuals with ASD" - the study was a good one because of its population-wide focus and the pretty good autism-related resources that Utah has (and has had for many years). It demonstrates once again that the difficult topic of suicide and autism should remain a research priority in order to identify who might be most at risk and why, alongside the ways and means that such risk *might* be mitigated (see here for one example).
And for those who might need someone to text / email / talk to, there are always options (see here for services in the UK or see here for those elsewhere).
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[1] Kirby AV. et al. A 20-year study of suicide death in a statewide autism population. Autism Res. 2019 Jan 21.
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Saturday, 5 January 2019
"an urgent need for autism treatment pathways in mental health services"
Of the many and varied important clinical and research areas connected to a diagnosis of autism or autism spectrum disorder (ASD), the provision of services to manage and treat mental health issues in the context of autism must rank high on the list of needs and priorities.It's with this in mind that I turn my blogging attention to the findings reported by Louise Camm-Crosbie and colleagues [1] and their findings observing three important themes around the issue of mental health and (adult) autism: "(1) difficulties in accessing treatment and support; (2) lack of understanding and knowledge of autistic people with co-occurring mental health difficulties and (3) appropriate treatment and support, or lack of, impacted autistic people’s well-being and likelihood of seeing suicide as their future." All of this is set within the idea that various mental health issues seem to be over-represented when it comes to autism (see here and see here and see here and see here for examples) and the lack of support and management of such issues can sometimes have devastating consequences (see here).
So: "In partnership with a steering group of autistic adults, an online survey was developed to explore these individuals’ experiences of treatment and support for mental health problems, self-injury and suicidality for the first time." The partnership bit ties in with the increasingly discussed 'participatory research' theme in some autism research circles (see here), where stakeholders are seen as partners driving a study or research agenda rather than just passive participants who are the topic of a particular study. The 'online survey' bit also continues a theme where technology means that participation doesn't mean having to be questioned face-to-face. Said survey was completed by 200 autistic adults ("122 females, 77 males and 1 unreported") and results covered an array of different issues, including some previously discussed by some authors on the Camm-Crosbie paper on other [important] research occasions (see here).
Alongside those three themes that emerged from the data, researchers also reported that: "In relation to treatment for mental health, self-injury and suicidality (n = 197), 164 participants (83.2%) were currently receiving/had previously received treatment, 29 participants (14.7%) needed/currently needed treatment but had not received it and 4 participants (2%) did not need treatment." As you can see from the figures, particularly that 2% not needing treatment, mental health issues (including self-injury and suicidality under that banner) are very much present when it comes to a diagnosis of autism, at least in this cohort.
Various other observations were reported on in the study; many of them pertinent to the another important theme coming from the article: "although participants reported experiences of being excluded from mental health services, with potentially tragic consequences for their well-being, there are also examples of participants benefitting from tailored support and treatment, which had a positive effect on their well-being." In other words, look to the individual and their wants, needs and wishes, and adapt accordingly. Not exactly rocket science.
So, what can be done to help ameliorate the issues identified by Camm-Crosbie et al and ensure that suitable 'tailored support and treatment' is offered? Well, the short answer is investment. Monetary investment. I could go for the 'low-hanging fruit' by saying that awareness of mental health issues in relation to autism needs to be improved among professional bodies, but the core material to aid such awareness is money. I could also go on about further dedicated resources needing to be put in place to support autistic adults (and children) with mental health issues, but the core material to get such resources is, once again, money. Money. And unfortunately in these austere times that we continually live in, where social care funding in particular, seems to have been cut to the bone, money for such issues is seemingly in short supply. Indeed, it seems that only when a crisis point is reached by an individual is anything actually done about something like mental health issues. And with all due respect to the hard working people who work in the mental health sector, after a crisis has been reached and 'managed', normal service seems to resume until another crisis comes along. The reason? Money yet again. The solution: put more money into this important issue. It will definitely help.
And whilst the focus of the Camm-Crosbie paper was adults with autism "without co-occurring intellectual disability", I also have to ask the question: what about those autistic people who are not able to complete online surveys and their mental health needs? Who's taking an interest in them? Are they, yet again, the understudied and underrepresented in autism research (see here)? There may be quite a bit to see [2]...
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[1] Camm-Crosbie L. et al. 'People like me don't get support': Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism. 2018 Nov 29:1362361318816053.
[2] Baudewijns L. et al. Problem behaviours and Major Depressive Disorder in adults with intellectual disability and autism. Psychiatry Res. 2018 Dec;270:769-774.
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Friday, 28 December 2018
"Psychotic experiences are important clinical markers of risk for future suicidal behavior"
The quote titling this post - "Psychotic experiences are important clinical markers of risk for future suicidal behavior" - comes from the systematic review and meta-analysis findings reported by Kathryn Yates and colleagues [1].Authors posed the research question: "Are psychotic experiences associated with an increased risk of later suicidal ideation, suicide attempt, and/or suicide death?" and looked to the existing peer-reviewed research literature to try and answer it. Based on the combined results from ten studies that "reported on 84 285 participants from 12 different samples and 23 countries" and met the inclusion criteria of their review, Yates et al made some important conclusions.
"Individuals who reported psychotic experiences had an increase in the odds of future suicidal ideation (5 articles; n = 56 191; odds ratio [OR], 2.39 [95% CI,1.62-3.51]), future suicide attempt (8 articles; n = 66 967; OR, 3.15 [95% CI, 2.23-4.45]), and future suicide death (1 article; n = 15 049; OR, 4.39 [95% CI, 1.63-11.78])." These are important statistics. They translate into some important details insofar as "individuals who reported PEs [psychotic experiences] had 2-fold increased odds of subsequent suicidal ideation, 3-fold increased odds of subsequent suicide attempt, and 4-fold increased odds of subsequent suicide death." Some further nifty statistical analysis from the authors looking into something called the population-attributable fraction (PAF), defined as "the proportion of incidents in the population that are attributable to the risk factor", suggested that the percentage figure for "PEs for suicide attempts and suicide deaths combined was 24.7%." That is also something rather important.
Should anyone be surprised by these results? Well, yes and no. Yes, because the magnitude of the association between PEs and suicidal behaviours was probably a lot more pronounced than many would have perhaps expected. No, because other literature has talked about psychosis in depression for example, as being potentially important to the development and presentation of suicidal behaviour (see here). Having said all that, I will reiterate that suicidal behaviours are very complicated.
Aside from the important issue of potentially expanding screening for suicidal behaviours when PEs are present, there are other factors to consider. Not least that: "The mechanisms explaining the association between PEs and suicidal behavior are potentially manifold." I was particularly interested in one theory put forward by the authors, suggesting that: "In the context of high stress and poorer communication skills, this might adversely affect the individual’s ability to formulate logical plans to manage perceived challenges and instead increase the likelihood of turning to suicide." Such an idea is based on other findings observing that there may be cognitive 'challenges' accompanying PEs that may impair problem-solving skills. Y'know, not having the skills to stop molehills from turning into mountains? Perhaps further research in this area might also turn to looking at some of the underlying biology behind such issues as well as the psychology. How, for example, inflammatory processes and the immune system *might* show some important involvement (see here and see here) for at least some people? One future avenue of research attention at least.
The data from Yates and colleagues is particularly poignant at the time of writing this post as the US CDC release figures suggesting that suicide mortality in the United States has climbed and climbed and climbed over the past few decades (see here). Again, the reasons are probably going to be complicated but that shouldn't stop people from continually asking 'why?' and 'what can we do about them?'
I close this post with some important contact details should anyone need someone to talk to (see here)...
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[1] Yates K. et al. Association of Psychotic Experiences With Subsequent Risk of Suicidal Ideation, Suicide Attempts, and Suicide Deaths. JAMA Psychiatry. 2018. Nov 28.
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Wednesday, 21 November 2018
Psychosis in depression linked to an increased risk of completed suicide
So, the name of the research games was systematic review and meta-analysis focused on both the peer-reviewed and 'gray' literature for studies "providing data on completed suicides in PMD [unipolar psychotic major depression] compared to non-PMD." Psychotic major depression by the way, is pretty much what the name suggests: depression or a depressive episode with the addition of psychotic symptoms such as hallucinations or delusions. Boiling down the pertinent research literature from thousands of articles to just nine articles covering "33,873 patients, among them 828 suicides", authors began their analyses.
Results: As already mentioned, the data pointed to the idea that psychosis might be an important part of suicide risk: "PMD patients manifest elevated risk of suicide even when they are compared with non-PMD patients who suffer from severe depression." Authors also concluded that: "This [suicide] risk is elevated in both the acute phase of the disorder and lifetime" and: "The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD’s suicide risk." The bottom line is that psychosis or the presence of symptoms of psychosis could be an important screening variable for risk of suicide in depression and also a target for intervention/prevention...
Before I go, I just want to head back to that previous sentence about these results perhaps having significance for 'different scenarios' where depression, psychosis and risk of suicide mix. I speak of course about the core topic of this blog - autism - and the on-going efforts to understand the complicated hows-and-whys of suicide risk in relation to autism (see here and see here). Acknowledging that the paths that take someone towards suicidality are often complex (see here), there is already some recognition in the peer-reviewed science domain that psychosis alongside autism might be a risk factor for suicide (see here). This, on the basis that psychosis and conditions manifesting psychosis might be 'over-represented' in relation to the autism spectrum (see here and see here) and depression is also not something unfamiliar (see here). It strikes me as eminently sensible that psychosis as well as depression could perhaps be screened more routinely as and when a diagnosis of autism is received. Both conditions/states are manageable...
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[1] Gournellis R. et al. Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis. Annals of General Psychiatry. 2018;17, 39.
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Thursday, 11 October 2018
Depressive symptoms in ADHD: "comparing child and parent reports"
I was drawn to blogging about the results published by Annie Fraser and colleagues [1] for a few reasons. Their observation that: "Young people with ADHD [attention-deficit hyperactivity disorder] are at high risk of experiencing symptoms of depression but may under‐report the severity of their symptoms" was interesting. It potentially ties into some other important observations about 'happiness' in the context of ADHD (see here) and also how there is an elevated risk of suicidality when ADHD is part of the clinical picture (see here). Similarly, it fits the narrative that various developmental and/or behavioural labels/conditions/disorders are typically never really stand-alone diagnoses...So: "This study used a subsample of children originally recruited as part of the Cardiff University Study of ADHD Genes and Environment (SAGE)." As per the 'comparing child and parent reports' part of the Fraser paper, both parents and children completed the Mood and Feelings Questionnaire (MFQ) to measures depressive signs and symptoms in participating children/young adults ("mean age was 14.6 years (range 8–20 years)"). The MFQ "is a widely used depression screening instrument" according to the authors, and has some pretty good backing. Results from the MFQ were compared with a non-ADHD (I assume?) general population sample from a similar part of the United Kingdom (UK) and statistics were applied.
Having already alluded to the observation that depression scores on the MFQ were higher (indicative of more depressive symptoms) in the ADHD group than the population control group (N=1460), there are some further details to mention. Both parent- and child-rated MFQs showed the trend of more depressive symptoms in participants with ADHD. And when it came to clinical cut-off points for suspected depression, quite a few more of those diagnosed with ADHD reached them compared with controls (parent‐report 54.5% vs. 10.6%... child‐report 32.4% vs. 10.5%).
"Amongst the most common depression symptoms found in our ADHD sample were difficulty concentrating, restlessness and feeling grumpy with parents. These symptoms overlap with those of ADHD, so it is unsurprising that they were common in our sample." Think of those last sentences in one particular context: the rise and rise of the term 'ESSENCE' (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) and all the chatter about how behavioural symptoms across various different labels seem to 'overlap' with one and another. How also, developmental and behavioural labels rarely exist alone or in some sort of diagnostic vacuum (see here for example). And add them to another sentence from the authors: "This could suggest that depression scores in this sample are artificially elevated by symptoms which overlap with ADHD symptoms." Indeed.
"Suicidal thoughts and symptoms of psychomotor and cognitive retardation (i.e. talking more slowly than usual, moving and walking more slowly than usual, and sleeping more than usual) were the lowest scoring symptoms on both parent‐ and child‐report." Having already mentioned those quite worrying statistics on how a diagnosis of ADHD seems to elevate the risk of suicidality, this might initially seem like better news from the Fraser paper. Items such as "S/he thought about death or dying.... S/he thought his/her family would be better off without him/her... S/he thought about killing him/herself" were not, in the majority, reported on with great fervour. But one needs to be cautious. I say that because the authors also added: "symptoms of suicidality (‘I thought about killing myself’) were present in 20%–25% of the ADHD sample, according to both parent‐report and child‐report, compared to 2%–7% of the population sample." This is a more worrying way of looking at the findings.
So to conclude: depression or depressive symptoms are no stranger to ADHD, the symptoms of ADHD probably overlap with some of the symptoms of depression (at least according to the MFQ), and an enhanced risk of suicidality seems to be confirmed as and when ADHD is diagnosed. There's more than enough further investigations to be done on those topics; perhaps also drawing on a few other important observations too (see here and see here and see here).
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[1] Fraser A. et al. The presentation of depression symptoms in attention‐deficit/hyperactivity disorder: comparing child and parent reports. Child and Adolescent Mental Health. 2018;23(3):243-250.
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Tuesday, 2 October 2018
Bipolar disorder and "completed suicide"
"Suicide rates in BD [bipolar disorder] vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population."
That rather sober sentence comes from the results of the systematic review published by Plans and colleagues [1] looking at "the existing literature of completed suicide in BD patients." As per the words 'completed suicide' this was a review article specifically focused on looking at studies examining the very final decision taken to end ones life and acting upon it. The authors did look at "suicide attempts and suicidal behaviour" during the course of their review but only in the context of completed suicide.
Then to the cold, objective science... over 60 articles met the authors inclusion criteria and allowed researchers to review "epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD." Aside from the quite startling risk of completed suicide in relation to a diagnosis of bipolar disorder, authors were also able to note some important risk variables too: "early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities." Another important statement was also made pertinent to that 'treatment' analysis: "Lithium is the only treatment that has shown anti-suicide potential" in line with other observations (see here).
What's more to say? Well acknowledging that the paths towards suicide are various and numerous (see here) and, more often that not, influenced by both internal and external factors, the connection between bipolar disorder and suicide risk is cemented by the Plans review. I could talk about how bipolar disorder and other depression-related illnesses (yes, illnesses) are potentially *connected* to various other diagnostic labels (see here for example) and, within that context, may very well influence suicide risk there too (see here). But there's nothing particularly novel about such discussions.
The 'lithium' bit to the Plans paper is also important to reiterate, and how such medication is truly a life-saver for some. As with all medicines, it does have a 'risk profile' [2] but, with appropriate monitoring, any side-effects need to be balanced against the very real risk highlighted by Plans et al.
And then there is the need for lots more scientific investigation in this area to directly 'tackle' bipolar disorder in terms of aetiology and pathology and logically onward, to impact on suicide risk...
To close, there are people to talk to (or text) if needed...
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[1] Plans L. et al. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord. 2018 Aug 23;242:111-122.
[2] Albert U. et al. Lithium treatment and potential long-term side effects: a systematic review of the literature. Riv Psichiatr. 2014 Jan-Feb;49(1):12-21.
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That rather sober sentence comes from the results of the systematic review published by Plans and colleagues [1] looking at "the existing literature of completed suicide in BD patients." As per the words 'completed suicide' this was a review article specifically focused on looking at studies examining the very final decision taken to end ones life and acting upon it. The authors did look at "suicide attempts and suicidal behaviour" during the course of their review but only in the context of completed suicide.
Then to the cold, objective science... over 60 articles met the authors inclusion criteria and allowed researchers to review "epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD." Aside from the quite startling risk of completed suicide in relation to a diagnosis of bipolar disorder, authors were also able to note some important risk variables too: "early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities." Another important statement was also made pertinent to that 'treatment' analysis: "Lithium is the only treatment that has shown anti-suicide potential" in line with other observations (see here).
What's more to say? Well acknowledging that the paths towards suicide are various and numerous (see here) and, more often that not, influenced by both internal and external factors, the connection between bipolar disorder and suicide risk is cemented by the Plans review. I could talk about how bipolar disorder and other depression-related illnesses (yes, illnesses) are potentially *connected* to various other diagnostic labels (see here for example) and, within that context, may very well influence suicide risk there too (see here). But there's nothing particularly novel about such discussions.
The 'lithium' bit to the Plans paper is also important to reiterate, and how such medication is truly a life-saver for some. As with all medicines, it does have a 'risk profile' [2] but, with appropriate monitoring, any side-effects need to be balanced against the very real risk highlighted by Plans et al.
And then there is the need for lots more scientific investigation in this area to directly 'tackle' bipolar disorder in terms of aetiology and pathology and logically onward, to impact on suicide risk...
To close, there are people to talk to (or text) if needed...
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[1] Plans L. et al. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord. 2018 Aug 23;242:111-122.
[2] Albert U. et al. Lithium treatment and potential long-term side effects: a systematic review of the literature. Riv Psichiatr. 2014 Jan-Feb;49(1):12-21.
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Monday, 10 September 2018
Internet addiction and suicidal behaviours meta-analysed
"This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression."
That was the research bottom line reported on by Yu-Shian Cheng and colleagues [1] following their meta-analysis of the peer-reviewed research literature looking at 'internet addiction' ("internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use") and suicidality.
Researchers, with some experience of meta-analysis it has to be said (see here and see here), trawled through the pertinent literature and settled on the analysis of some 25 studies, including over a quarter of a million participants, that looked at internet addiction and suicidal ideation, planning, and attempts. Boiling the data down, they observed some important *associations* that even held when important variables linked to suicidal behaviours - depression for example - were adjusted for. Children it seems, were also more 'vulnerable' to the link between internet addiction and suicidality. The authors caution that cause-and-effect were not proven from their analysis of the collected data, bearing in mind "the evidence was derived mostly from cross-sectional studies" but call for further investigations in this area.
This is an important area of research. As per some of the previous studies conducted on internet overuse and suicidality [2], there are some important further investigations to be undertaken on for example, the various types of online activity that might increase the risk of suicidality: "online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt." This in the context that social media use in particular, is under the spotlight when it comes to various different health issues (see here). Alongside gambling disorder, so it looks like gaming disorder is set to enter the diagnostic texts too (see here), where 'lack of control' and causing "significant impairment in personal, family, social, educational, occupational or other important areas of functioning" are key features. And minus any sweeping generalisations, 'control' *could* actually be a key element to consider when it comes to suicidal behaviours in certain circumstances.
Bearing in mind that this blog is predominantly concerned with autism research, I couldn't help but think about how the Cheng findings *might* relate to [some] autism. How for example, a diagnosis of autism also seems to elevate the risk of suicidality (see here) and how issues like depression are not uncommon in the context of autism (see here). I'm also minded to mention how compulsive internet use *might* show some important connections to the presentation of autistic traits [2] and how videogame use, in particular (see here), might have both positives and negatives in the context of autism [3].
By saying all that, I don't want to make any sweeping generalisations; the label of autism has had enough of those down the years. I don't also want to demonise the wonderful resource that is the internet, particularly when pastimes like gaming and social media use can be a good 'social' outlet for many people on the autism spectrum and beyond when used in moderation. Certainly the internet, through things like social media, provides an important voice and potentially quite a lot more to those whose voices might previously not have been heard...
But perhaps when it comes to the next stage of any research plan looking at internet overuse / addiction and suicidal behaviours it might be worth considering whether some of the features of autism or other, related labels [4] (see here) *might* also moderate any relationship. Whether there are some relevant lessons to be learned that *might* reduce the very worrying statistics on suicide and autism, and whether activities other than those done on online, could perhaps be seen as 'protective factors' when it comes to suicide risk (see here for example)?
Bear all that in mind by all means. But remember also that the paths that take someone to such suicidal behaviours are often numerous and individual. Internet overuse is probably only a small part of an often bigger and more complicated picture.
And in case anyone needs to talk or text, there's always someone who will listen (see here).
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[1] Cheng YS. et al. Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761.
[2] Lin IH. et al. The association between suicidality and Internet addiction and activities in Taiwanese adolescents. Compr Psychiatry. 2014 Apr;55(3):504-10.
[3] Mazurek MO. & Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord. 2013 Jun;43(6):1258-71.
[4] Wang B. et al. The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. BMC Psychiatry. 2017;17:260.
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That was the research bottom line reported on by Yu-Shian Cheng and colleagues [1] following their meta-analysis of the peer-reviewed research literature looking at 'internet addiction' ("internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use") and suicidality.
Researchers, with some experience of meta-analysis it has to be said (see here and see here), trawled through the pertinent literature and settled on the analysis of some 25 studies, including over a quarter of a million participants, that looked at internet addiction and suicidal ideation, planning, and attempts. Boiling the data down, they observed some important *associations* that even held when important variables linked to suicidal behaviours - depression for example - were adjusted for. Children it seems, were also more 'vulnerable' to the link between internet addiction and suicidality. The authors caution that cause-and-effect were not proven from their analysis of the collected data, bearing in mind "the evidence was derived mostly from cross-sectional studies" but call for further investigations in this area.
This is an important area of research. As per some of the previous studies conducted on internet overuse and suicidality [2], there are some important further investigations to be undertaken on for example, the various types of online activity that might increase the risk of suicidality: "online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt." This in the context that social media use in particular, is under the spotlight when it comes to various different health issues (see here). Alongside gambling disorder, so it looks like gaming disorder is set to enter the diagnostic texts too (see here), where 'lack of control' and causing "significant impairment in personal, family, social, educational, occupational or other important areas of functioning" are key features. And minus any sweeping generalisations, 'control' *could* actually be a key element to consider when it comes to suicidal behaviours in certain circumstances.
Bearing in mind that this blog is predominantly concerned with autism research, I couldn't help but think about how the Cheng findings *might* relate to [some] autism. How for example, a diagnosis of autism also seems to elevate the risk of suicidality (see here) and how issues like depression are not uncommon in the context of autism (see here). I'm also minded to mention how compulsive internet use *might* show some important connections to the presentation of autistic traits [2] and how videogame use, in particular (see here), might have both positives and negatives in the context of autism [3].
By saying all that, I don't want to make any sweeping generalisations; the label of autism has had enough of those down the years. I don't also want to demonise the wonderful resource that is the internet, particularly when pastimes like gaming and social media use can be a good 'social' outlet for many people on the autism spectrum and beyond when used in moderation. Certainly the internet, through things like social media, provides an important voice and potentially quite a lot more to those whose voices might previously not have been heard...
But perhaps when it comes to the next stage of any research plan looking at internet overuse / addiction and suicidal behaviours it might be worth considering whether some of the features of autism or other, related labels [4] (see here) *might* also moderate any relationship. Whether there are some relevant lessons to be learned that *might* reduce the very worrying statistics on suicide and autism, and whether activities other than those done on online, could perhaps be seen as 'protective factors' when it comes to suicide risk (see here for example)?
Bear all that in mind by all means. But remember also that the paths that take someone to such suicidal behaviours are often numerous and individual. Internet overuse is probably only a small part of an often bigger and more complicated picture.
And in case anyone needs to talk or text, there's always someone who will listen (see here).
----------
[1] Cheng YS. et al. Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761.
[2] Lin IH. et al. The association between suicidality and Internet addiction and activities in Taiwanese adolescents. Compr Psychiatry. 2014 Apr;55(3):504-10.
[3] Mazurek MO. & Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord. 2013 Jun;43(6):1258-71.
[4] Wang B. et al. The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. BMC Psychiatry. 2017;17:260.
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Wednesday, 15 August 2018
On the question of suicide risk and chronic fatigue syndrome / myalgic encephalomyelitis continued
The paper by Andrew Devendorf and colleagues [1] brought me back to a complicated and sensitive topic previously discussed on this blog (see here) regarding the issue of suicide risk in the context of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Specifically, the Devendorf findings provide some potentially important information about the possible reasoning behind suicide risk in the context of ME/CFS: "(1) feeling trapped and (2) loss of self, loss of others, stigma and conflict."
Based on discussions with 29 people diagnosed with ME/CFS "who endorsed suicidal ideation but did not meet depression criteria" researchers, including one Leonard Jason (see here), discussed some of the hows-and-whys of such suicidal ideation. As per the 'did not meet depression criteria' sentiments of the research, this work was less about 'mental health diagnoses affecting suicide risk' and more about how thoughts, feelings and situational factors might play a role. And as per the two variables highlighted by the study - 'feeling trapped' and 'loss of self & others and the stigma and conflict' generated by this incapacitating condition(s), some clear areas for further research and clinical attention emerged.
I've covered the sensitive issue of suicide (risk, ideation, completion) quite a few times on this blog for all-manner of different reasons (see here and see here for examples). In the most part, my musings have been on research into suicide where a specific label/condition/disorder has been diagnosed, and how facets of such labels/conditions/disorders *might* at least partially, 'intrinsically' elevate the risk of suicide ideation or beyond. The Devendorf findings kinda deviate from such 'intrinsic' sentiments, insofar as examining the implications of an acquired physical disability (see here and see here) and the onward the physical (and mental) restrictions of a condition seemingly elevating the risk of suicidality. By saying all that, I'm not making any sweeping generalisations...
I don't think anyone should really be surprised by the Devendorf results. With ME/CFS you have a condition that literally steals life from people; for example, rendering previously fit and active people to sometimes being bed-bound for days and days (or even longer) at a time. Add in a 'boom-bust' pattern of symptoms (see here) and the various 'environmental' effects (to employment, finances, social life, etc) of the condition, and well, I'm often surprised how resilient people with ME/CFS are.
I noted also how the words 'stigma' and 'conflict' were also detailed in the Devendorf study, and what implications this might have for quite a few areas of current research and clinical practice in relation to ME/CFS. I'm thinking specifically about the whole 'biopsychosocial (BPS) thing' that seems to have pervaded ME/CFS thinking down the years (see here), and how psychology in particular, seems to have over-stepped it's usefulness in relation to ME/CFS. It's kind of a coincidence that as I write this post, another article including Keith Geraghty [2] on the authorship list, is published discussing how some ME/CFS patients and patient groups have been labelled as 'militant' (or similar words and phrases) on the basis of them pushing back against medical dogma as a function of their own experiences of BPS-backed 'intervention' for example (see here). Militant is one word that has been used, 'vexatious' is another (see here).
"Participants emphasized that they were not depressed, but felt trapped by the lack of treatments available." This sentence serves to reiterate that suicidality in the context of ME/CFS is perhaps not something that should necessarily be thought of as intrinsic to the condition(s). It emphasises how issues like 'hopelessness' at the state of medical knowledge about ME/CFS, about the lack of biological explanation for the condition, and the lack of intervention options (not BPS guided I might add) may play a role in thoughts and feelings related to suicidality. It also provides another rather pressing reason why less 'psychologising' and more biological science needs to be dedicated to the hows-and-whys of ME/CFS and the search for a cure...
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[1] Devendorf AR. et al. Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness. J Health Psychol. 2018 Jul 1:1359105318785450.
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Based on discussions with 29 people diagnosed with ME/CFS "who endorsed suicidal ideation but did not meet depression criteria" researchers, including one Leonard Jason (see here), discussed some of the hows-and-whys of such suicidal ideation. As per the 'did not meet depression criteria' sentiments of the research, this work was less about 'mental health diagnoses affecting suicide risk' and more about how thoughts, feelings and situational factors might play a role. And as per the two variables highlighted by the study - 'feeling trapped' and 'loss of self & others and the stigma and conflict' generated by this incapacitating condition(s), some clear areas for further research and clinical attention emerged.
I've covered the sensitive issue of suicide (risk, ideation, completion) quite a few times on this blog for all-manner of different reasons (see here and see here for examples). In the most part, my musings have been on research into suicide where a specific label/condition/disorder has been diagnosed, and how facets of such labels/conditions/disorders *might* at least partially, 'intrinsically' elevate the risk of suicide ideation or beyond. The Devendorf findings kinda deviate from such 'intrinsic' sentiments, insofar as examining the implications of an acquired physical disability (see here and see here) and the onward the physical (and mental) restrictions of a condition seemingly elevating the risk of suicidality. By saying all that, I'm not making any sweeping generalisations...
I don't think anyone should really be surprised by the Devendorf results. With ME/CFS you have a condition that literally steals life from people; for example, rendering previously fit and active people to sometimes being bed-bound for days and days (or even longer) at a time. Add in a 'boom-bust' pattern of symptoms (see here) and the various 'environmental' effects (to employment, finances, social life, etc) of the condition, and well, I'm often surprised how resilient people with ME/CFS are.
I noted also how the words 'stigma' and 'conflict' were also detailed in the Devendorf study, and what implications this might have for quite a few areas of current research and clinical practice in relation to ME/CFS. I'm thinking specifically about the whole 'biopsychosocial (BPS) thing' that seems to have pervaded ME/CFS thinking down the years (see here), and how psychology in particular, seems to have over-stepped it's usefulness in relation to ME/CFS. It's kind of a coincidence that as I write this post, another article including Keith Geraghty [2] on the authorship list, is published discussing how some ME/CFS patients and patient groups have been labelled as 'militant' (or similar words and phrases) on the basis of them pushing back against medical dogma as a function of their own experiences of BPS-backed 'intervention' for example (see here). Militant is one word that has been used, 'vexatious' is another (see here).
"Participants emphasized that they were not depressed, but felt trapped by the lack of treatments available." This sentence serves to reiterate that suicidality in the context of ME/CFS is perhaps not something that should necessarily be thought of as intrinsic to the condition(s). It emphasises how issues like 'hopelessness' at the state of medical knowledge about ME/CFS, about the lack of biological explanation for the condition, and the lack of intervention options (not BPS guided I might add) may play a role in thoughts and feelings related to suicidality. It also provides another rather pressing reason why less 'psychologising' and more biological science needs to be dedicated to the hows-and-whys of ME/CFS and the search for a cure...
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[1] Devendorf AR. et al. Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness. J Health Psychol. 2018 Jul 1:1359105318785450.
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Friday, 10 August 2018
"Risk markers for suicidality" and autism: masking or insight as a feature?
The findings reported by Sarah Cassidy and colleagues [1] continue an important research theme in relation to risk of suicide and autism (see here). The value-added bit to their research on this occasion was the observation that "there are unique factors associated with autism and autistic traits that increase risk of suicidality" and that some of these factors may be potentially modifiable.
Members of this research team have some important research history [2] when it comes to looking at suicidality and autism. This time around they report the results of an on-line survey completed by over 160 adults on the autism spectrum and a similar number of not-autistic controls. Prior to the delivery of this survey we are told that a steering group of autistic adults / adults with autism helped to target the research towards what factors might be relevant, including: "non-suicidal self-injury, mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC [autism spectrum condition] diagnosis, and ‘camouflaging’ ASC."
"Results are consistent with previous findings that autistic adults are at significantly increased risk of suicidality compared to the general population." As worrying as that finding is, the observation that suicidality is elevated in relation to autism is nothing new. Indeed, as far back as the late 1990s, there were rumblings of 'under-reporting' of suicidality in relation to autism and related developmental disorders.
Continuing: Various psychiatric labels/conditions were identified as being present in those with autism at a greater frequency than controls. This included various 'comorbidities' previously discussed with autism in mind (see here and see here). Several of those conditions have also been identified as key risk variables when it comes to suicidality. I was also particularly drawn to the rate of personality disorder (PD) identified in this sample: 18% in females with autism compared with 3-4% in control females for example. This is interesting in light of other research explored on this blog (see here) and again, some evidence of an enhanced risk for suicide alongside such a condition. And mention of 'Myalgic encephalopathy' I assume akin to Myalgic Encephalomyelitis (ME), another mainstay topic of this blog, perhaps taps into an area that requires lots more study on the possible overlap between autism and ME/CFS (chronic fatigue syndrome) (see here). Indeed, in future posts I'll be [again] covering research on the issue of suicide in relation to ME/CFS [3] that could also be relevant to autism and ME/CFS when co-occurring, reiterating that ME/CFS is not a psychiatric or mental health diagnosis...
Onward: "These results suggest that autism diagnosis and autistic traits explain significant additional variance in suicidality beyond a range of known risk factors, and are therefore independent risk markers for suicidality." So 'autistic traits as being independent risk markers for suicidality'. This is not the first time that such peer-reviewed sentiments have been reported (see here) and probably won't be the last. The logical implications from such a finding is that a reduction in autistic traits may well impact on suicidality. This is not a sentiment that some people will find palatable, but that's the logical implication stemming from such a finding.
Finally, quite a lot has been made (on social media at least) about the issue of camouflaging (masking) and a possible connection to suicidality in relation to autism. Masking reflects the idea that some on the autism spectrum actively camouflage signs and symptoms "in order to cope in social situations." The authors report that: "Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC [autism spectrum conditions]." I'm however slightly cautious of this at the moment when wearing my objective science hat. One has to remember that, at present, there aren't many (any?) well validated tools for objectively assessing masking in relation to autism. In this study, Cassidy and colleagues mention how: "A brief set of four questions were designed to quantify tendency to camouflage." The answers to such a small set of open questions are subject to considerable bias (particularly if the individual is active on social media and perhaps privy to all the discussions around masking on there). One also cannot discount the idea that having the fundamental ability of 'insight' to be able to mask/camouflage may itself be a risk factor for suicidality. I say this on the basis of other research talking about how a higher cognitive capacity in relation to autism seems to increase the risk of vulnerability to depression (see here) as a function of the link between depression and suicidality. Simple answers to complex questions are likely to be few and far between.
So, where next? Well, being careful not to fall into any sweeping generalisations or psychobabble explanations of suicide risk in relation to autism, it strikes me that there are a few things to think about in terms of harm reduction. Screening for something like depression and/or non-suicidal self-injury (NSSI) should be much more widespread in the context of autism. Obviously, such behaviours / diagnoses are not just 'locked in' over a lifetime, so such screening needs to be done quite regularly. I would also mention that other comorbidity seemingly over-represented when it comes to autism might also exert an important effect too (see here). Tackling 'unmet support needs' also looks to be important. I'm slightly less sure of how to go about affecting this, given that the availability of many services are seemingly at the whim of finances and resources, which continue to be in short supply in these austere times (see here). But where there's a will, there's a way. I'll also reiterate that if certain autistic traits are themselves independent risk factors for suicidality, it surely follows that moves to reduce such behaviours would impact on suicidality. Indeed, in this context, the active process of masking could be seen as a double-edged sword when it comes to suicidality and autism.
And I'm also minded to bring in some important literature where autism is talked about in the context of euthanasia and assisted suicide (see here) and what lessons could be learned from some of the accounts detailed there. It's another difficult topic to discuss but something that is becoming increasingly relevant (see here).
As always, if you need someone to talk to (or text), there are organisations available. Please use them.
----------
[1] Cassidy S. et al. Risk markers for suicidality in autistic adults. Mol Autism. 2018 Jul 31;9:42.
[2] Cassidy S. et al. Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014 Jul;1(2):142-7.
[3] Devendorf AR. et al. Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness. J Health Psychol. 2018 Jul 1:1359105318785450.
----------
Members of this research team have some important research history [2] when it comes to looking at suicidality and autism. This time around they report the results of an on-line survey completed by over 160 adults on the autism spectrum and a similar number of not-autistic controls. Prior to the delivery of this survey we are told that a steering group of autistic adults / adults with autism helped to target the research towards what factors might be relevant, including: "non-suicidal self-injury, mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC [autism spectrum condition] diagnosis, and ‘camouflaging’ ASC."
"Results are consistent with previous findings that autistic adults are at significantly increased risk of suicidality compared to the general population." As worrying as that finding is, the observation that suicidality is elevated in relation to autism is nothing new. Indeed, as far back as the late 1990s, there were rumblings of 'under-reporting' of suicidality in relation to autism and related developmental disorders.
Continuing: Various psychiatric labels/conditions were identified as being present in those with autism at a greater frequency than controls. This included various 'comorbidities' previously discussed with autism in mind (see here and see here). Several of those conditions have also been identified as key risk variables when it comes to suicidality. I was also particularly drawn to the rate of personality disorder (PD) identified in this sample: 18% in females with autism compared with 3-4% in control females for example. This is interesting in light of other research explored on this blog (see here) and again, some evidence of an enhanced risk for suicide alongside such a condition. And mention of 'Myalgic encephalopathy' I assume akin to Myalgic Encephalomyelitis (ME), another mainstay topic of this blog, perhaps taps into an area that requires lots more study on the possible overlap between autism and ME/CFS (chronic fatigue syndrome) (see here). Indeed, in future posts I'll be [again] covering research on the issue of suicide in relation to ME/CFS [3] that could also be relevant to autism and ME/CFS when co-occurring, reiterating that ME/CFS is not a psychiatric or mental health diagnosis...
Onward: "These results suggest that autism diagnosis and autistic traits explain significant additional variance in suicidality beyond a range of known risk factors, and are therefore independent risk markers for suicidality." So 'autistic traits as being independent risk markers for suicidality'. This is not the first time that such peer-reviewed sentiments have been reported (see here) and probably won't be the last. The logical implications from such a finding is that a reduction in autistic traits may well impact on suicidality. This is not a sentiment that some people will find palatable, but that's the logical implication stemming from such a finding.
Finally, quite a lot has been made (on social media at least) about the issue of camouflaging (masking) and a possible connection to suicidality in relation to autism. Masking reflects the idea that some on the autism spectrum actively camouflage signs and symptoms "in order to cope in social situations." The authors report that: "Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC [autism spectrum conditions]." I'm however slightly cautious of this at the moment when wearing my objective science hat. One has to remember that, at present, there aren't many (any?) well validated tools for objectively assessing masking in relation to autism. In this study, Cassidy and colleagues mention how: "A brief set of four questions were designed to quantify tendency to camouflage." The answers to such a small set of open questions are subject to considerable bias (particularly if the individual is active on social media and perhaps privy to all the discussions around masking on there). One also cannot discount the idea that having the fundamental ability of 'insight' to be able to mask/camouflage may itself be a risk factor for suicidality. I say this on the basis of other research talking about how a higher cognitive capacity in relation to autism seems to increase the risk of vulnerability to depression (see here) as a function of the link between depression and suicidality. Simple answers to complex questions are likely to be few and far between.
So, where next? Well, being careful not to fall into any sweeping generalisations or psychobabble explanations of suicide risk in relation to autism, it strikes me that there are a few things to think about in terms of harm reduction. Screening for something like depression and/or non-suicidal self-injury (NSSI) should be much more widespread in the context of autism. Obviously, such behaviours / diagnoses are not just 'locked in' over a lifetime, so such screening needs to be done quite regularly. I would also mention that other comorbidity seemingly over-represented when it comes to autism might also exert an important effect too (see here). Tackling 'unmet support needs' also looks to be important. I'm slightly less sure of how to go about affecting this, given that the availability of many services are seemingly at the whim of finances and resources, which continue to be in short supply in these austere times (see here). But where there's a will, there's a way. I'll also reiterate that if certain autistic traits are themselves independent risk factors for suicidality, it surely follows that moves to reduce such behaviours would impact on suicidality. Indeed, in this context, the active process of masking could be seen as a double-edged sword when it comes to suicidality and autism.
And I'm also minded to bring in some important literature where autism is talked about in the context of euthanasia and assisted suicide (see here) and what lessons could be learned from some of the accounts detailed there. It's another difficult topic to discuss but something that is becoming increasingly relevant (see here).
As always, if you need someone to talk to (or text), there are organisations available. Please use them.
----------
[1] Cassidy S. et al. Risk markers for suicidality in autistic adults. Mol Autism. 2018 Jul 31;9:42.
[2] Cassidy S. et al. Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014 Jul;1(2):142-7.
[3] Devendorf AR. et al. Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness. J Health Psychol. 2018 Jul 1:1359105318785450.
----------
Thursday, 7 June 2018
"ADHD was a risk factor for suicide attempt"
The findings reported by Kai-Lin Huang and colleagues [1] continue an important research theme (see here) on how a diagnosis of attention-deficit hyperactivity disorder (ADHD) may increase the risk of suicidal behaviours (see here). Further, that timely management of the symptoms of ADHD via indicated pharmacological means in particular, may provide some important risk-reduction from such behaviours; again substantiating previous investigations in this area (see here).Based, yet again, on the fabulous but now sadly non-functional resource that is/was the National Health Insurance Research Database (NHIRD) in Taiwan, researchers undertook a "longitudinal cohort study [that] enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009." This is yet another example of Taiwanese 'big data' in action on the important topic of suicide (see here and see here). Alongside detailing any psychiatric comorbidities accompanying the diagnosis of ADHD, Huang and colleagues looked for diagnostic codes indicating suicide attempt(s) and whether or not medication(s) clinically indicated for ADHD were prescribed.
Results: "ADHD was an independent and direct risk factor for any suicide attempt, and an even stronger risk factor for repeated suicide attempts." As per my previous blogging forays into this topic, such news is by no means novel. The use of "long-term methylphenidate treatment" being associated with "a significantly decreased risk of repeated suicide attempts in men with ADHD" is also not new news, but does once more, provide yet more evidence for the use of such strategies and their seeming effects well beyond just symptom reduction/management.
What's more to say? Well, one might need to delve a little more into what it is about ADHD that *might* predispose to such extremes of behaviour. Whether this be a heightened risk of other comorbidity occurring as a function of ADHD (see here) impacting on suicidal behaviour(s) or something rather more directly linked to ADHD (see here), there is a schedule of further research to continue. I'm also minded to direct your attention to the findings reported by Mars and colleagues [2] and how general population 'risk factors' might also provide some clues. Minus any medical or clinical advice given or intended, I'll reiterate how the use of something like lithium seems to be quite useful in the context of potentially reducing suicide risk (see here) and how further work perhaps needs to be done on this compound with specific focus on suicide risk and ADHD. I say this, bearing in mind that lithium has a risk profile of its own.
Oh, and need I remind you that ADHD as being an 'over-represented' feature of autism for quite a few people (see here) might also imply some 'association' in the very serious statistics talking about suicide risk in the context of autism (see here)...
Again, if anyone needs to talk to someone, there are organisations out there willing to listen.
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[1] Huang KL. et al. Risk of suicide attempts in adolescents and young adults with attention-deficit hyperactivity disorder: a nationwide longitudinal study. Br J Psychiatry. 2018 Mar 4:1-5.
[2] Mars B. et al. What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population-based birth cohort study. J Child Psychol Psychiatry. 2018 Mar 1.
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Wednesday, 16 May 2018
The headline: "One in nine young people in Scotland have attempted suicide"
I have to say that I drew a sharp intake of breath when I read the media headline titling this post - "One in nine young people in Scotland have attempted suicide" - based on the findings reported by Rory O'Connor and colleagues [1]. The idea that, from a sample of some 3500 young people in Scotland, some 10% and 15% of respondents to the questions: "Have you ever made an attempt to take your life, by taking an overdose of tablets or in some other way?’ and ‘Have you ever deliberately harmed yourself in any way but not with the intention of killing yourself? (i.e. self-harm)" answered in the affirmative, seemed pretty important. Not least with the question 'why?' in mind.
OK, media headlines aside, the O'Connor findings require some dissection. The reasoning behind studying this issue was not only to look at the very complicated topic of suicide in a part of the UK (Scotland) that authors write "has a higher suicide rate than England", but also to try and understand how non-suicidal self-injury (NSSI) or non-suicidal self-harm (NSSH) presents in young adults and whether there is something important linking NSSH and suicidal thoughts and/or attempts.
The participant group was drawn from "a representative sample of young people aged 18–34 years from across Scotland" who were recruited to the Scottish Wellbeing Study. Lots of measures were completed by participants as part of the wider study initiative but we are told that "only the prevalence of NSSH and suicide attempts information is reported" in the O'Connor article on this occasion. I might also add that participants were compensated to the tune of £25 (pounds sterling) for their time and participation.
Alongside those headline findings on self-reported attempted suicide and self-harm, a few other important trends were observed. So: "More than 20% reported lifetime suicidal thoughts, 2.4% reported that they last thought about suicide in the past week and 10.4% reported they last thought about suicide in the past 12 months." Around 6% of respondents reported that they had both attempted suicide and also engaged in self-injury suggesting that professionals should "routinely enquire about history of self-injurious behaviour, especially as past behaviour is such a strong predictor of suicide." Also: "Earlier age at NSSH or suicide attempt onset was associated with more frequent lifetime NSSH and suicide attempts." And finally: "The prevalence of NSSH and suicide attempts was significantly higher among those classified as unemployed... and economically inactive... compared with those who were employed." Age, societal and environmental factors seem to play some roles too.
Then to another important set of questions: (a) why? and (b) what can be done to reduce these headline-grabbing statistics? Well, there are no easy answers to such questions I'm afraid. The authors do note that: "From a public health perspective, the unemployment and economic inactivity findings are noteworthy" and perhaps suggest that there are some modifiable variables that could influence suicidal thoughts and/or actions focused on getting people into employment and the benefits that this brings (wide-ranging benefits by all accounts). But this probably only covers one side of the issue, as discussions inevitably turn to what role psychiatric and/or behavioural comorbidity might play in such reporting (see here and see here and see here) and whether there may be a need for (a) something like enhanced screening for suicidal thoughts or other 'risks' among selected populations and/or (b) the [careful] use of 'preventative' strategies in such cases (see here and see here). I say all that accepting that diagnoses around mental health probably play an important role in suicide-related behaviours but are not necessarily a pre-requisite...
As always, there is always someone to talk to if needed...
----------
[1] O'Connor RC. et al. Suicide attempts and non-suicidal self-harm: national prevalence study of young adults. BJPsych Open. 2018; 4: 142-148.
----------
OK, media headlines aside, the O'Connor findings require some dissection. The reasoning behind studying this issue was not only to look at the very complicated topic of suicide in a part of the UK (Scotland) that authors write "has a higher suicide rate than England", but also to try and understand how non-suicidal self-injury (NSSI) or non-suicidal self-harm (NSSH) presents in young adults and whether there is something important linking NSSH and suicidal thoughts and/or attempts.
The participant group was drawn from "a representative sample of young people aged 18–34 years from across Scotland" who were recruited to the Scottish Wellbeing Study. Lots of measures were completed by participants as part of the wider study initiative but we are told that "only the prevalence of NSSH and suicide attempts information is reported" in the O'Connor article on this occasion. I might also add that participants were compensated to the tune of £25 (pounds sterling) for their time and participation.
Alongside those headline findings on self-reported attempted suicide and self-harm, a few other important trends were observed. So: "More than 20% reported lifetime suicidal thoughts, 2.4% reported that they last thought about suicide in the past week and 10.4% reported they last thought about suicide in the past 12 months." Around 6% of respondents reported that they had both attempted suicide and also engaged in self-injury suggesting that professionals should "routinely enquire about history of self-injurious behaviour, especially as past behaviour is such a strong predictor of suicide." Also: "Earlier age at NSSH or suicide attempt onset was associated with more frequent lifetime NSSH and suicide attempts." And finally: "The prevalence of NSSH and suicide attempts was significantly higher among those classified as unemployed... and economically inactive... compared with those who were employed." Age, societal and environmental factors seem to play some roles too.
Then to another important set of questions: (a) why? and (b) what can be done to reduce these headline-grabbing statistics? Well, there are no easy answers to such questions I'm afraid. The authors do note that: "From a public health perspective, the unemployment and economic inactivity findings are noteworthy" and perhaps suggest that there are some modifiable variables that could influence suicidal thoughts and/or actions focused on getting people into employment and the benefits that this brings (wide-ranging benefits by all accounts). But this probably only covers one side of the issue, as discussions inevitably turn to what role psychiatric and/or behavioural comorbidity might play in such reporting (see here and see here and see here) and whether there may be a need for (a) something like enhanced screening for suicidal thoughts or other 'risks' among selected populations and/or (b) the [careful] use of 'preventative' strategies in such cases (see here and see here). I say all that accepting that diagnoses around mental health probably play an important role in suicide-related behaviours but are not necessarily a pre-requisite...
As always, there is always someone to talk to if needed...
----------
[1] O'Connor RC. et al. Suicide attempts and non-suicidal self-harm: national prevalence study of young adults. BJPsych Open. 2018; 4: 142-148.
----------
Tuesday, 24 April 2018
Suicide risk in ADHD (based on a selective review)
The paper by Giancarlo Giupponi and colleagues [1] makes for pretty sombre reading in relation to the question of suicide risk in attention-deficit hyperactivity disorder (ADHD). Accepting that there were methodological differences among the various peer-reviewed studies included for [selective] review, authors' findings were along similar lines to what has previously been reported: "many studies indicate an association between ADHD and suicidal behavior."
I'm not going to say too much about the Giupponi findings on this blogging occasion, because they kinda speak for themselves. As well as covering quite a bit of research talking about suicidal behaviour in the context of child/adolescent and adult ADHD and the issue of "whether there is a direct relationship or whether the association depends on the increased prevalence of pre-existing comorbid conditions and individual and family dysfunctional factors", authors also mention the important role played by various medicines clinically indicated for ADHD as potentially being protective against suicidal behaviour(s) (see here). From a methodological perspective, I would have liked to have seen a table or something illustrating all the studies included in the Giupponi 'selective review' but oh-um...
The authors conclude by recommending that "patients with ADHD should be routinely screened for suicidal behavior, and early intervention protocols should be established in order to detect and reduce suicidal ideation and behavior and to improve the quality of life." I don't think anyone would disagree with such sentiments, added to what is already becoming known about suicidal behaviour in a more general context (see here). Given also the increasingly close proximity of ADHD to another label / conditions / diagnosis frequently discussed on this blog (see here) also including some enhanced suicide risk too (see here), I daresay that routine screening might extend much further than some might realise...
----------
[1] Giupponi G. et al. Suicide risk in attention-deficit/hyperactivity disorder. Psychiatr Danub. 2018 Mar;30(1):2-10.
----------
I'm not going to say too much about the Giupponi findings on this blogging occasion, because they kinda speak for themselves. As well as covering quite a bit of research talking about suicidal behaviour in the context of child/adolescent and adult ADHD and the issue of "whether there is a direct relationship or whether the association depends on the increased prevalence of pre-existing comorbid conditions and individual and family dysfunctional factors", authors also mention the important role played by various medicines clinically indicated for ADHD as potentially being protective against suicidal behaviour(s) (see here). From a methodological perspective, I would have liked to have seen a table or something illustrating all the studies included in the Giupponi 'selective review' but oh-um...
The authors conclude by recommending that "patients with ADHD should be routinely screened for suicidal behavior, and early intervention protocols should be established in order to detect and reduce suicidal ideation and behavior and to improve the quality of life." I don't think anyone would disagree with such sentiments, added to what is already becoming known about suicidal behaviour in a more general context (see here). Given also the increasingly close proximity of ADHD to another label / conditions / diagnosis frequently discussed on this blog (see here) also including some enhanced suicide risk too (see here), I daresay that routine screening might extend much further than some might realise...
----------
[1] Giupponi G. et al. Suicide risk in attention-deficit/hyperactivity disorder. Psychiatr Danub. 2018 Mar;30(1):2-10.
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